National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 1366784

Government Disclaimer on use of this data

Case Details

VAERS ID: 1366784 (history)  
Form: Version 2.0  
Sex: Unknown  
Location: Unknown  
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Bell's palsy, Guillain-Barre syndrome, Thrombosis
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hearing impairment (broad), Hypersensitivity (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210556206

Write-up: BELL''S PALSY; BLOOD CLOT; GUILLAIN BARRE SYNDROME; ANAPHYLAXIS; This spontaneous report received from a patient via a company representative (other manufacturer Pfizer ) concerned multiple patients. The patient height and weight was not reported .No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported)frequency one total , dose, start therapy date were not reported for prophylactic vaccination.The batch no was not reported ,The Company is unable to performed follow up to request batch /Lot numbers. No concomitant medications were reported. On an unspecified date, the subject experienced bell''s palsy, blood clot, guillain barre syndrome, and anaphylaxis. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the bell''s palsy, blood clot, guillain barre syndrome and anaphylaxis was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0. 20210556206-COVID-19 VACCINE AD26.COV2.S. Bell''s palsy, Blood clot, Guillain Barre syndrome. This events is considered unassessable. The events has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the events. 20210556206-COVID-19 VACCINE AD26.COV2.S. Anaphylaxis. This event is labeled per RSI and is therefore considered potentially related.

New Search

Link To This Search Result:

Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166